Stroke treatment utilizing extravascular circulation of oxygenated synthetic nutrients to treat tissue hypoxic and ischemic disorders

Abstract

A novel acute care cerebral support system and method for treating severly ischemic brains is disclosed wherein an oxygenated nutrient emulsion is circulated through at least a portion of the ventriculo-subarachnoid spaces. The nutrient emulsion contains an oxygenatable non-aqueous component, an aqueous nutrient component, an emulsification component, and other components which render physiologic acceptability to the nutrient emulsion. The disclosed system and method have been shown to effectively exchange oxygen, carbon dioxide, glucose, and other metabolites in severely stroked brains. Significant restoration of oxidative metabolism and electrographic activity result from the disclosed treatment. Methods for producing the nutrient emulsion and a system for delivering that emulsion to the cerebrospinal pathway are also disclosed. Additionally, novel diagnostic methods for diagnosing the physiologic state of hypoxic-ischmeic and other diseased neurologic tissue during treatment are provided.

What is claimed is: 
     
       1. A method of making an oxygenatable synthetic nutrient cerebrospinal treatment fluid for treating hypoxic-ischemic central nervous system tissue, comprising the steps of: (a) emulsifying an oxygenatable fluorocarbon non-aqueous material with a synthetic electrolyte-containing cerebrospinal aqueous fluid to produce a physiologically acceptable emulsion;   (b) normalizing the electrolytes and adjusting the pH of said emulsion to produce an osmotically equilibrated and acid-base balanced emulsion;   (c) adding nutrients to said emulsion to produce said oxygenatable synthetic nutrient treatment fluid, said nutrients comprising at least one amino acid; and   (d) oxygenating said fluid.   
     
     
       2. The invention of claim 1 wherein said electrolytes are normalized to produce a hypertonic osmolarity, whereby said treatment fluid, after oxygenation, is further useful for counteracting edema of said hypoxic-ischemic neurologic tissues. 
     
     
       3. The invention of claim 1 wherein step (i) comprises adding at least one essential amino acid. 
     
     
       4. The invention of claim 1 wherein step (i) comprises adding at least one carbohydrate. 
     
     
       5. The invention of claim 1 wherein step (i) further comprises adding glucose. 
     
     
       6. The invention of claim 1 wherein step (i) comprises adding a steroid. 
     
     
       7. A method for treating hypoxic-ischemic central nervous system tissues using an oxygenatable synthetic nutrient cerebrospinal treatment fluid, comprising the steps of: (a) emulsifying an oxygenatable non-aqueous material with a synthetic cerebrospinal fluid to produce a physiologically acceptable emulsion;   (b) normalizing the electrolytes and adjusting the pH of said emulsion to produce an osmotically equilibrated and acid-base balanced emulsion;   (c) adding nutrients to said emulsion to produce said oxygenatable synthetic nutrient treatment fluid;   (d) oxygenating said synthetic nutrient treatment fluid to produce an oxygenated synthetic nutrient treatment fluid;   (e) injecting said oxygented synthetic nutrient treatment fluid into a cerebrospinal pathway;   (f) withdrawing said treatment fluid from said cerebrospinal pathway to create a circulation of said oxygenated synthetic nutrient treatment fluid in the vicinity of said hypoxic-ischemic central nervous system tissue.   
     
     
       8. The method of claim 7 wherein said oxygenatable non-aqueous material is selected to be a fluorocarbon liquid, and where said mixing comprises mixing a ratio of said fluorocarbon to synthetic cerebrospinal fluid of between 1:1 and 1:8. 
     
     
       9. The method of claim 7 wherein said synthetic cerebrospinal fluid consists essentially of an aqueous solution of calcium, magnesium, sodium, chloride and potassium. 
     
     
       10. The method of claim 7 wherein step (a) further the step of dialyzing said emulsion into additional amounts of said synthetic cerebrospinal fluid to improve the physiologic acceptability thereof. 
     
     
       11. The invention of claim 7 comprising the additional step of adding, after step (a), an effective amount of an antibiotic material. 
     
     
       12. The invention of claim 11 wherein said additional step of adding antibiotic material comprises adding bacitracin. 
     
     
       13. The invention of claim 12 wherein said step of adding bacitracin is conducted to add an amount sufficient to obtain a concentration of at least about 1000 units per liter of oxygenatable nutrient emulsion. 
     
     
       14. The invention of claim 12 wherein step (a) comprises filtering through filter paper. 
     
     
       15. The invention of claim 7 wherein said normalizing step is conducted to achieve a normalization of sodium to about 131, potassium to about 3.8, chloride to about 13 and CO 2  to about 3. 
     
     
       16. The method of claim 7 wherein step (b) is conducted to adjust said pH to between about 7.30 and 7.42. 
     
     
       17. The invention of claim 7 wherein the temperature of said oxygenatable nutrient emulsion is adjusted to about 37° C. for injection. 
     
     
       18. The invention of claim 7 wherein said temperature of said oxygenatable nutrient emulsion is adjusted to below 37° C. for injection to thereby provide a hypothermic treatment modality. 
     
     
       19. The invention of claim 7 wherein said temperature of said oxygenatable nutrient emulsion is adjusted to below 37° C. for injection to thereby provide a hypothermic treatment modality.